Friday 30 October 2020

Lupine Publishers | Early Interventions to Promote Pediatric Oral Health

 Lupine Publishers | Journal of Pediatric Dentistry


It is well established that dental caries is the most prevalent and preventable chronic disease among children [1]. Preschool years are a critical period of development; poor oral health can create lifelong consequences for one’s overall health outcomes. If oral health needs are not addressed earlier, it may negatively impact a child’s ability to eat, sleep, learn or socialize, further damaging the child’s psychological and social dimensions of well-being [1,2]. Another negative outcome is the need for dental surgery as it accounts for 31% of all surgeries among children under the age of 6 [3]. Caries in childhood is a predictor for adult oral health; this may affect other health conditions such as diabetes or cardiovascular disease over time [2]. Caries is a multifactorial chronic disease influenced by biological, lifestyle, and behavior factors [4]. Risk factors for early childhood caries include: bacteria transmission from mother to infant [5]; the social determinants of health [2]; parental knowledge [6], attitudes and behaviors towards oral health (e.g., diet, pacifier use, and daily tooth brushing); prolonged bottlefeeding practices [7], and cultural beliefs around primary or “milk teeth” [8,9]. Oral health is connected to socioeconomic status; those with higher income are more likely to access a dentist and have dental insurance coverage [10]. It is important to identify effective interventions targeting preschool children in order to collaborate with the Family Health Division, other Regional departments, and community partners to meet the emerging oral health needs of our community.

Future Directions

The recommendations made decades ago to promote early childhood oral health by establishing a dental home before the first birthday, and providing education and preventive interventions, are crucial components of effective care [11]. Now, as then, dental professionals play a pivotal role by assessing and monitoring the individualized risk of each pediatric patient and applying the latest evidence-based approaches to disease prevention and treatment [12]. Effective care requires a constant review the literature, ongoing assessment of the rapidly evolving understanding of the oral microbiome and its effect on caries progression and implementing management protocols as early as possible. Beyond the clinic, however, it is equally important for dental teams to provide parents/caregivers with the knowledge and skills to make appropriate dietary and lifestyle choices for their children, while ensuring proper oral hygiene and regular dental visits. It is only through these combined efforts that oral disease can be prevented.

Key Takeaways

a) Establishing a dental home before a child’s first birthday ensures a safe place for comprehensive care and allows clinicians to develop recommendations specific to that patient’s individualized risk.

b) Assessing caries risk and implementing preventive strategies are critical elements of pediatric care, particularly for preschoolers and children with special

c) health care needs.

d) Parents and caregivers must be given the means to mitigate the child’s caries risk through effective self-care and healthy lifestyle choices, and by working with dental teams to verify whether the risk management regimen has been effective.

e) It is only through the combined efforts of dental professionals and parents/caregivers that oral disease can be prevented.

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Lupine Publishers | Ear, Nose and Throat Disorders in Renal Patients

 Lupine Publishers | Journal of Otolaryngology


Patients with renal disease can present with acute renal failure (RF), chronic RF, and end-stage renal disease. Specific otolaryngologic disorders can associate the underlying etiology of acute renal diseases such as infections and autoimmune diseases or its drug therapy. Moreover, chronic RF is associated with hypertension, uremia, renal osteodystrophy and platelets dysfunction. Renal replacement therapy has inherent risk of anticoagulation with hemodialysis and immunosuppression with kidney transplantation.

Keywords: Autoimmune Disease; ENT; Drug Side Effect; Renal Failure


1,000 people a year [1]. Chronic RF affects about 1 in 1,000 people with 3 per 10,000 people newly develop the condition each year [2]. Patients with RF can present with acute RF, chronic RF, and endstage renal disease (ESRD) [3]. The latter is severe, irreversible and advanced kidney disease. Patients with acute RF can be managed conservatively with

a. elimination of the offending factor such as dehydration, drug-allergy (acute interstitial nephritis), infection/ autoimmune disease and obstruction of urinary tract and

b. correction of complications of RF viz. uremia, hyperkalemia and fluid overload and their drug-therapy. If already have severe RF; temporary (supportive) dialysis is done till recovery [4].

On the other hands; chronic RF is due to hereditary disorders such as Alport’s and polycystic kidney disease as well as primary and secondary glomerulopathy (GN), previous reflux nephropathy (chronic pyelonephritis), hypertension and neglected obstruction. Those patients are managed with

a. control of the underlying disease to prolong kidney survival,

b. control of co-morbid conditions associated with RF viz. hypertension, hyperkalemia, fluid overload, renal osteodystrophy and anemia

c. decrease intraglomerular pressure to decrease glomerulosclerosis, to prolong kidney survival, with angiotensin converting enzyme inhibitors/angiotensin receptors blockers (ACEI/ARB) and low-protein diet, and

d. renal replacement therapy (RRT) with maintenance dialysis and subsequently kidney transplantation if they had reached ESRD [5].

Kidney transplantation is done, if ESRD patients are fit for it and already have donors. The main problems with RRT are

a. anticoagulation, usually with heparin which lasts for 4-6 hours post hemodialysis session and

b. immunosuppressive side-effects of agents used to prevent rejection in the transplanted kidney.

Immunosuppression is usually heavy in the first 3-months and can be associated with bacterial infections while viral, fungal and parasitic opportunistic infections and certain malignancies can develop later [6].



a) Tinnitus: Hypertension and uremia.

b) Vertigo: Hypertensive cerebella/pontine lacunar infarct.

c) Drowsiness: Dehydration, hypo/hyperglycemia, electrolytes disturbances especially hyponatremia, hypercalcemia, diabetic neuropathy, drugs viz. Aldose (+ postural hypotension), sedatives or Lyrica, anticonvulsants,

d) Deafness: Sensori-neural deafness with Alport’s and drug induced viz. high-dose Lasix and Aminoglycosides.

e) Trigeminal Neuralgia: Can be mistaken for local ear/ teeth disorder or CVA/migraine.

f) TB of middle and inner ear and herpes zoster, candida and pyogenic otitis externa in immunocompromised patients.


a) Pharyngitis: Epstein-Barr virus (EBV) infection can present with prolonged fever, coated tonsils, lymphadenopathy, weight loss. Moreover, mouth ulcers are common in patients with systemic lupus erythematosus (SLE), Bechet’s disease and GERD. Oral and esophageal candidiasis (thrush) is common following steroid-therapy and mouth ulcers after Mycophenolate and Methotrexate treatment. Mycophenolate is notorious in induction of fever, dyspnea, mouth ulcers and diarrhea due to activation of Cytomegalovirus infection (CMV). URTI can lead to post-strep GN (a self-limited hypertension, proteinuria and hematuria). A similar yet recurrent pattern can be seen coinciding with URTI due to IgA nephropathy (spheritic GN). Throat pain with lymphoid hyperplasia is a common side-effect of ACEI and rarely with ARB.

b) Dry Mouth: Sicca syndrome (Sjogren’s). Drugs viz. Calcitriol, Clonidine, Codeine, anti-emetic, antihistaminics, antidepressants, diuretics (Amelioride, HCTZ, Torosemide), Omeperazole, Prazocin, Physio tens and Tramadol.

c) Gingival Hyperplasia: usually due to drugs viz. Phenytoin, Cyclosporine A, Calcium channel blockers

d) Renal osteodystrophy: rarely affects teeth yet bony cavitary lesions (Brown tumors) and ostemalacia with poor bone healing if patients are subjected to ENT surgery.

e) Hoarseness: GERD, ACEI, angioneurotic edema, or vocal cord palsy after thyroid/parathyroid surgery. Also; diseases such as hypothyroidism, multiple sclerosis and myasthenia gravis.



) Epistaxis: Hypertension, moderate renal disease + platelets dysfunction, thrombocytopenia (SLE, myeloproliferative diseases, drug induced, EBV, CMV) and excessive heparin during hemodialysis/anti-platelet and anticoagulants.

b) Nasal/paranasal destructive lesions: in Granulomatosis with polyangiitis (Wegner’s vasculitis) which manifests with nasal/ paranasal/middle and inner ear/pulmonary disease.

c) Allergic rhinitis and asthma-like: Hypersensitivity angrites (Churg-Strauss vasculitis) and drug-induced (NSAIDs).

Most Important Message

a) Avoid NSAIDs in treating patients with renal disease [7].

b) Avoid dye study without consulting a nephrologist [8].

c) Adjust dose of some antibiotic.

d) Renal patients have premature atherosclerosis: CVA, renovascular hypertension, pre-mature hearing loss [9].

e SLE and vasculitis are a multi-system autoimmune disease with hematological disorders and thrombotic potentials as well as associated with multiple side-effects of medications viz. corticosteroids and immunosuppressive agents. The latter can predispose to life threatening viral, bacterial and fungal infections as well as malignancies [10].

f) Reactivation of latent TB is common in dialysis and transplant patients since immunocompromised.


OL manifestations in kidney patients; may be the tip of the iceberg of multiple reno/medical disorders and can aid in and their management.

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Wednesday 28 October 2020

Lupine Publishers | Onion (Allium cepa) Production in Urban and Peri-Urban Areas: Financial Performance and Importance of This Activity for Market Gardeners in Southern Benin

 Lupine Publishers | Current Investigations in Agriculture and Current Research


Food safety has always been and continues to be a major concern for all countries of the world. This concern is all the more perennial in the developing countries like Benin with a low economic level and still rudimentary and extensive agriculture. To reduce a little bit of food insufficiency, is developed urban and peri-urban agriculture based mainly on market gardening. This study focused particularly on the production of onion in southern Benin. It aims to analyze its performance, to understand the importance of this activity but also to see what are the obstacles faced by these producers. Three municipalities were investigated: Grand-Popo, Cotonou and Sèmè-Kpodji. A total of 60 farmers were surveyed at 20 per municipality. Quantitative and qualitative tools were combined for the analysis of data collected through individual and group interviews. A joint analysis approach was used to achieve specific objectives. It consists to combine speech analysis, participant observation with statistical tools such as the frequency distribution, the regression model and calculation of performance indicators. It follows from all of these analyzes that onion production is profitable from a financial point of view. This performance is enhanced by factors such as age, experience and membership of a producer group. Similarly, the farmers claimed for majority that onion occupies a special place in their market garden production. This production improves their socio-economic and food situations. However, the constraints that undermine the more onion production and thus constitute important producer concerns are financial, institutional, organizational, property constraints and those directly related to production. Farmers therefore, expect a little more effort from agricultural policies to improve the development of this sector.

Keywords: Onion, Performance, Importance, Barriers, Southern Benin


The agricultural sector provides essentially food security and livelihood in Benin, with 70% of the population earning their income from agriculture [1]. This sector is even more important for developing countries like Benin, where it is one of the pillars of the economy [2]. Nowadays, it is increasingly recognized that in the developing world, nearly three billion people live on less than US $2 per day [3]. Majority of this population are smallholder farmers producing staple food crops with little prospects of generating higher incomes. Hence, diversification into high-value horticulture is essential for increasing farm incomes, alleviating poverty and improving livelihoods [4,5]. Globally, food production is still a challenge [6,7], especially with the projected rise in world population to over 9 billion by 2050 and increased urbanization in cities [8]. There is therefore still some justification for increasing agricultural production in the coming years [9,10]. Urban vegetable production is an intensive agricultural strategy through which urban dwellers secure income and improve their livelihoods [11].Urban and periurban agriculture (UPA) has been defined differently by Mougeot [12,13], Moustier [14], and Van Veenhuizen [15], but they all lay stress on agriculture’s relationship with the city as a resource and destination for outputs [16].

Onion (Allium cepa L.) is one of the most important commercial spice crops of the world belongs to Amaryllidaceae family [17]. Moreover, essential oil and sulfur compounds have been found in onion which is responsible for unique odour, flavour, and taste [18]. Based on the interested situation in health food development, the properties of onion and its extract as a functional agent have been demonstrated in many previously [19]. Onion (Allium cepa L.) has been valued as food and medicinal plant since ancient times [20]. It is widely cultivated secondly to tomato, and is a vegetable bulb crop known to most cultures and consumed worldwide [21]. The major onion producing countries of the world are China, India, USA, Turkey, Japan, Spain, Brazil, Poland and Egypt [22]. In Benin West African country, this culture has become very important especially in urban areas where the market gardeners devote more land to the production of onion. It is in order to make an inventory and understand onion production in southern Benin that this study was conducted. Specifically, the study aims to analyze firstly the profitability of onion production, secondly to appreciate the importance of onion production in southern Benin and ending by identifying the difficulties facing the farmers.

Materials and Methods

Study zone

The municipalities of Grand-Popo, Sèmè-Kpodji and Cotonou are located in south of Benin and cover respectively 289km², 250km² to 79km². The town of Grand Popo is located in the southwestern department of Mono. It is limited to the north by the Athiémé, Comé and Houéyogbé communes, south by the Atlantic sea, to the southwest by the communes of Ouidah and Kpomassè and west by the Republic of Togo. Located between the parallel 6° 22 ‘and 6° 28’ north latitude and the meridian 2° 28 ‘and 2° 43’ east longitude, the commune of Sèmè-Kpodji is in the Department of Ouémé, the Southeast of the Republic of Benin on the Atlantic coast. It is limited to the north by the city of Porto Novo and Aguégué, south by the Atlantic sea, to the east by the Federal Republic of Nigeria and to the west by the city of Cotonou. The town of Cotonou in turn is located on the barrier beach that stretches between Nokoué Lake and the Atlantic sea, consistitued of alluvial sands of about five meters maximum height. It represents the only municipality in the Littoral department is bounded to the north by the municipality of Sô-Ava and Nokoué Lake, south by the Atlantic sea, to the east by the town of Seme-Kpodji and West by that of Abomey-Calavi. These towns are from a set that has a sub-equatorial climate except Sèmè-Kpodji bathed in a Guinean Sudanese climate. We find in these areas, the sandy type of soil, leached and hydromorphic. The municipalities of Grand-Popo, Sèmè-Kpodji and Cotonou have various socio-cultural group included the mina, the Goun, the Xwla and Toffins.


To conduct this research, three (03) municipalities were selected in southern Benin. These towns were chosen partly because of their significant contribution to the onion production of the department to which they belong, and secondly because of the large number of onion producers they contain. We have Grandpopo, Sèmè-Kpodji and Cotonou. Therefore, (60) producers made object of investigation at the rate of twenty (20) producers per commune. This sample consists only of onion producers. Note that the sample was achieved in a simple random in order to give all producers the same probability of being selected. Table 1 show the composition of the sample per commune: The collected data is related not only to the characteristics of the producers, but also to expenditure and revenue of producers. The information has been collected on the basis of a questionnaire and a pre-prepared interview guide.

Table 1: Composition of the sample per commune.


Source: Results of investigation, 2018.

Data analysis

In this study, the performance of onion production in southern Benin was assessed using several indicators of financial performance. To this end, it is inspired by the work of Dédéwanou [23]. Several profitability indicators were therefore calculated, namely: Gross Product Value (PBV), Added Value (VA), the Gross Operating Income (RBE) and Net Operating Income (RNE). From Adégbola [24] and Bockel [25] studies, these indicators can be calculated as follows:

a) Product Gross Value (PBV): Denoting by Q the quantity of onion obtained and PU the selling price of the kilogram, the Gross Product Value (PBV) is given by: PBV = Q*PU.

b) The PBV is for this purpose the revenue made by the producer.

c) Added Value (VA): It corresponds to the difference between the Raw Product Noise Value and the value of intermediate inputs (CI). Intermediate consumption represents expenses related to the acquisition of insecticides, herbicides, and baskets. Its formula is given by: VA=PBV-CI.

d) The added value is obtained by deducting from the PBV, all expenses directly related to the production. Note that the added value is the wealth that the producer creates. This wealth contributes to the Gross Domestic Product of the country.

e) Gross Operating Income (RBE): It is given by the formula: RBE=VA-(Labor compensation + financial expenses + taxes). To estimate the RBE, it was considered only the hired labor.

f) Net Operating Income (RNE) This indicator represents the balance of RBE less the value of depreciation. Its formula is given by: RNE=RBE-Amortization.

g) The RNE expresses the gain (or loss) Economic agent once acquitted all current operating expenses. RNE, expresses the economic gain (or loss) given the investments made previously. Therefore RNE is obtained by deducting from the PBV all expenses related to production.

h) This study is also proposed to analyze the determinants of the profitability of onion production. For this purpose this study was based on the work of Tovignan [26] and Allagbe [27]. A multiple linear regression model has been developed on the basis of sixty (60) onion producers. Thus, the multiple linear regression formula can be written as follow:

y =α01xi+ εi

Where: y is the dependent variable, xi the explanatory variables, α is a constant called “intercept” and Ɛi the error term of the model.

The evaluation of the importance of onion production consists to determine changes in socio-economic and food orders induced by this production in the three investigated municipalities. To do this, in a collection of producer’s speeches about perceived improvements since they produce onion was done. The analysis fundamentally was based on the discourse of these producers and through participant observation. More simply, the analysis consists to explain the effects induced by the production of onion in a social context through producer’s speeches and participant observation. These explanations were supported by the comments of some significant producers. The frequency distribution and the farmer’s speeches allowed identifying the barriers of onion production in the study areas.

Presentation of the variables included in the model

Two types of variables are included in the regression model turned. We have on the one hand, the dependent variable and the other explanatory variables. The dependent variable is the Net Operating Income of producers. It was therefore question of identified and analyzed the factors influencing the income of onion producers. So many variables called ‘’ explanatory ‘’ were introduced in the regression model. The explanatory variables included in the model are: age of the producer (Age), household size (Mena), the number of agricultural household assets (ActifM), the level of literacy (Alpha), educational level (Inst), seniority (Anc), membership of a group (APPG), the cultivated area (Sup), the mode of land access (ACCT) and fixed costs (CF).

There are a lot of reasons for the incorporation of these variables in the regression model.

a) Age: Age is a variable expressed in years. Several studies identify age as a parameter determining the profitability of agricultural production. Indeed, the more the producer is aged, the more he gains experience enabling him to improve the financial performance of its operations. This variable has been introduced into the model to see if it has an influence on the net income of onion producers in South Benin. The age would have a positive effect on the financial performance of onion production.

b) Mena: This variable refers to the number of persons who form the household of the producer. Household size is a potential source of labor and allows producers to increase production. It therefore positively influences the net income of the onion producer.

c) ActfM: This variable represents the number of agricultural workers of producer household. The number of assets would have a positive effect on the profitability of production because the market garden production, especially onions requires a lot of labor.

d) Alpha and Inst: Education can acquire a base regarding the management of a exploitation. So, educated onion producers will have a higher income than their uneducated counterparts. The effect of literacy and education on the net income would be positive.

e) Old: This is the number of the producer seniority year. Over the producer has a number of high year of seniority, the more he has strengths and knowledge that will enable him to improve his onion production. It therefore positively influences the net income of the onion producer.

f) APPG: This variable represents the membership or not of the producer to a group. It is a binary variable taking the values 1 if the producer is a member of an onion producer group or 0 if not. This variable could have a positive effect on financial performance of the production, in the sense that the producer’s group members have the support of extension services as well as that of some development programs and projects in order to improve their performance.

h) ACCT: This variable represents the farmer’s access mode to the ground. This variable is set to 0 if the producer has access to land by inheritance; 1 if access rental. The fact that the onion producer owns the piece of land to his work, it could have an influence on his income because the latter will invest the necessary capital. A positive or negative sign of the coefficient for this variable would be expected.

i) CF: Fixed costs represent costs of production. Over were these expenses less producers take advantage of his farm. These variables will therefore have a negative effect on net income of onion producers.

Table 2: Summary of the model variables and the expected signs.


Source: Results of literature searches, 2018.

Table 2 shows a summary of all the variables included in the model with their expected signs. Note that two software’s were used in this section. SPSS has achieved descriptive statistics and STATA software was used to perform econometric regression.

Results and Discussion

A zoom on onion production and consumption

The following Table 3 shows the countries that produce most of onion in the world. China and India are the primary onion growing countries, followed by the USA, Egypt, Iran, Turkey, Pakistan, Brazil, the Russian Federation, and the Republic of Korea [21]. Onion productivity is highest in the Republic of Korea (66.16t/ ha), followed by the USA (56.26t/ha), Spain (53.31t/ha), and the Netherlands (51.64t/ha). With world production of 74,250,809 tonnes from an area of 4,364,000 hectare, the average productivity across the world is 19.79t/ha. The international trade in onion exports is 6.77 million tonnes. The Netherlands is the highest onion exporter (1.33 million tonnes) followed by India, China, Egypt, Mexico, USA, Spain, and Argentina. Bangladesh, Malaysia, the Russian Federation, the UK, Japan, and Saudi Arabia are the major onion importing countries in the world [21]. According to Bethesda [28], West Africa represents less than 2% of the world output of onion. However, it represents 10±25% of the vegetables consumption in West Africa: its culture is ancient in the region and extends through several agro-ecological zones, ranging from arid Sahelian countries to humid coastal countries [29]. In Benin particularly, the production of the onion is relatively young (40-50 years) [30].

Table 3: The ten largest producers of onion in the world.


Source: FAO, 201221.

If there is no recent and clear statistics of the volume of domestic onion production, it should be noted that the production has been in galloping development of around 70,000 tonnes against 15,000 just 20 years ago. According to Baco [31] and Affomasse [32], the average area of onion production is 1 ha in Benin representing 57% of total area under vegetable crops. Onion is the market garden predominant crop in Benin since it is grown by more than 80% of vegetable growers. Similarly, the onion is a product consumed by all the urban and rural beninese. Urban consumption is estimated at 3.3kg of onions per year per person. This demand represents a commercial demand for 7000 tonnes per year. The consumption of rural populations against is estimated at 1.1 kg of onions per year per person, a rural consumption of about 14 000 tonnes. Although the production of onion is growing, the country is unable to meet domestic demand of around 45,000 tonnes [33] throughout the year, which explains the need to import the remaining, mainly by Niger, Gaya-Malanville border [34].

Source of supply and sector’s actors

Niger, Burkina Faso, Nigeria and Benin are the biggest onion supply sources to West African consumers. Niger is the largest producer and exporter of onion in West Africa and its commercial network allows to supply the major coastal markets of the sub region. In Benin, for against the import of this speculation is more important because domestic production cannot meet the needs of people. However, nationally the most productive zones are Malanville, Karimama and Grand-Popo followed by large cities (Cotonou, Sèmè-Kpodji, Ouidah, Dassa and Glazoué) that also produce a considerable quantity of onion as urban or suburban vegetable. The production of onion, like most agricultural crops in Benin knows two periods: a period of abundance (January to May) characterized by high availability of onions on the market. Currently, importers of other countries (Nigeria, Burkina Faso, Nigeria) are sourcing local onion to neighboring countries. The second period, that of solder (August to December) is characterized by the scarcity of onions and increasing the product price on the market. In Benin, onion varieties are encountered onion Galmi (or white Galmi onion), purple Galmi (or onion Agades) and Dendi onion of Malanville (red onion or local onion). Of these varieties, the white Galmi remains the favorite onion for Beninese consumers. Besides his characteristics that one knows (bigger than the red onion, relatively smooth, easier to maintain, less spicy (less acidic)), it is its organoleptic qualities that are most appreciated (the pleasant flavor that it gives to the sauce and the fact that it does not blacken). Regarding the sale price of onions, it knows a big fluctuation depending on the period as specified above. Thus, the bag of 100kg of acceptable quality onion (red onion Galmi) and the most appreciated (white Galmi onion) respectively cost 14,500 CFA and 19,500 CFA in times of plenty against respectively 50,000 CFA and 75.000 CFA in lean period. Table 4 shows the selling price of 100 kg bag of different onion varieties in the study area.

Table 4: selling price of 100 kg bag of cultivated varieties of onion.


Source: Results of investigation, 2018.

The actors in the Value Chain (VC): a multitude of stakeholders

The onion sector is composed of a large number of actors can be subdivided into four groups. It is the operators of the value chain; supporters of the chain; institutional actors; stakeholders and external facilitators

a) The operators of the value chain are most concerned. They are upstream of the value chain and are for the most part the first owners of the product. They represent producers, sellers or resellers, customers or buyers, processors, intermediaries, wholesalers and retailers.

b) The supporters of the chain are those that are not directly related to the process of production or marketing. They are actors who sell their services to producers, processors and traders. This is usually suppliers of inputs (seeds, fertilizers, pesticides), moneylenders or credit providers, pumps sellers and gasoline retailers, MFIs, intermediaries, carriers, of agricultural laborers, carters to transport the onion over a short distance etc.

c) Institutional actors are the actor’s group that provides institutional support in the context of a continuous improvement and regulation of the sector activities. These include state structures (MAEP, CECPA, SCDA, customary chiefs, customs, police, gendarmerie, research and extension services etc.). The finding done is that these groups of actors do not really invest in the development of the sector.

d) Stakeholders and external facilitators are actors who aim to improve the socio-economic life of rural populations. They provide financial and technical support primarily to producers. These are NGOs, development projects and programs, and specific fund donors.

Downstream of the chain, there is a last group of actors which is relatively large: The consumers. Onion Consumers can be at any level of the chain. He may be the producer and in this case he practices subsistence farming or firm that process onion for example. It is important to note that in this sector, the actors play complementary roles. The value chain would not be good if each group of actors not playing its role effectively. The following Figure 1 shows schematically the various actors in the onion value chain in Southern Benin: In fact, some of the onions harvested by farmers are sold to rural collectors or directly to local markets. Intermediaries and wholesalers, for their part, buy onion for the most part from rural collectors or local markets. The purchased stock is then transported to urban markets (for example the Dantokpa,Malanville and Parakou markets). However, it should be noted that some producers sell their crops directly in these urban markets. The following circuit (Figure 2) shows the onion commercialization process described by respondent’s producers. All actors in the chain are present and the complementary relationship they have in the onion value chain.

Figure 1: Groups of actors in the Onion value chain in Benin.

Source: Results of investigation, 2018.


Figure 2: Process of marketing of onion value chain.

Source: Results of investigation, 2018.


Potential and motivations of onion producers

The onion production in both North and South Benin is favored by some natural assets available in the country. It is:

a) Agro-ecological potential of Benin (soils, climate, topography, vegetation, drainage network).

b) The geographical location of Benin (proximity to other producing countries such as Niger, Nigeria, Burkina Faso and other countries onion importers like Togo).

In addition to the natural potential, certain provisions promote onion production in Benin. We can talk about:

a) Mechanized irrigation through pumps for irrigation, from the shallow groundwater.

b) Interventions of many projects to support the intensification and promotion of fruit and vegetable crops.

c) Applied search to identify ways of improving vegetable production.

d) The producer’s enthusiasm for onion cultivation due to its high profitability.

e) The supply in specific inputs (Improved seeds, products pesticides, fertilizers...) from the 2000s.

f) Existence of market garders communal groups.

g) The existence of an international market and many village markets.

Especially for urban producers surveyed (Cotonou, Seme- Kpodji and Grand Popo) these are the following benefits that motivate these market gardeners to engage in the cultivation of onion.

a) The high financial profitability of onion production

b) More favorable conditions for the intensification of production systems, due to land pressure and pluriactivity that promote the enhancement of complementarities.

c) The geographical proximity to markets (Dantokpa market for example) reduces transportation costs compared to remote rural areas.

d) The reduction of energy and time in getting goods to consumers: transport, storage, especially for fresh produce.

e) The reduction of post-harvest losses due to the proximity of production areas.

f) Better product quality in terms of freshness for perishable products.

Socioeconomic and demographic characteristics of the surveyed producers

In southern Benin, specifically in the municipalities of Grand-Popo, Sèmè-Kpodji, and Cotonou onion production is predominantly male (78.3% of men against 21.7% of women). These producers have an average age of 28 (±08) with a tenure of 06 years (±04). Moreover, in the study area average household has 04 persons (±02) and 03 (±01) agricultural assets. Levels of literacy and education of the surveyed producers are more or less acceptable in public Grand-Popo, Sèmè-Kpodji and Cotonou. Note also that 50% of producers are active members of a group against a second half not belonging to a producer group. Overall, there are 81.7% literate farmers and 91.7% educated farmers. In the study zone, onion producers have an average area under crop of 2785.48 m2. These areas are obtained either legacy (61.7%) or rent (38.3%). To operate their farms, producers face two types of loads in their exploitations. These called ‘’variables’’ and those ‘’fixed’’. These charges are respectively 93 CFA/m2 and 5.76 CFA/m2. Table 5 shows the statistical variables characterizing respondents.

Table 5: Statistical variables characterizing respondents.


Source: Results of investigation, 2018.

Financial Performance of onion production

To assess the financial performance of onion production, analysis of operating farmers account was made. Thus, the results of the analysis reported in Table 4 shows that onion production is profitable in southern Benin as the average Net Operating Income calculated is positive (689 CFA/m2>0). These results are consistent with those of MAHRH [35] and Fanou [36] whose studies finally led to the conclusion that onion production is profitable. Table 6 below shows the operating account of onion producers. Note that the financial performance indicators used were calculated in CFA/m2.

Table 6: Financial performance indicators calculated.


Source: Results of investigation, 2018.

Determinants of onion production profitability

The multiple linear regression model performed to identify the determinants of the onion production profitability is generally significant at the 1% level (p=0.0000<1%). Variables such as age of the producer, the cultivated area, the level of literacy, membership in a group, the experience, and fixed costs are those which influence the onion production profitability in southern Benin. The variables of the model that are not significant are: household size, the number of farm assets, access to land and the level of producer instruction. Age has a positive significant effect on the threshold of 1% on the profitability of onion production. We therefore deduce that more the producer is old, more sometimes he took advantage of its business. The producer thus gains experience with time. Which experience allows him to improve the financial performance of his exploitations? However, these producers are very few open to new technologies that are proposed to improve their income. They therefore remain conservative. This conclusion stems from the fact that seniority has a negative significant effect on the threshold of 1% on the profitability of onion production. It is the same for literacy that has a negative and significant effect on the threshold of 1% on the profitability of onion production in southern Benin. These results are contrary to those obtained by Labiyi [37] which identify education as a determinant of economic efficiency of resource allocation in soybean production in Benin. Membership of the producer group has a positive and significant effect at the 10% threshold on the profitability of onion production.

Thus, onion producers who are members of a group have higher net profits than the others because they will benefit from certain advantages. We can highlight the sharing of information, mutual assistance and the expertise that a producer can take the other being a member of an onion producer group. These results are consistent with those of Tovignan [26] who found that producers who are members of a group have a higher net profit than others who do not belong to any group. Unlike the membership of a producer group, the wheat area has a negative and significant effect on the threshold 5% on the profitability of his exploitations. Thus, over the cultivated area, the less the onion producer benefits from his activities. The producers do not manage to meet the obligations belong to large farms. Note that these results contradict those obtained by Tovignan [26] who deduced that producers who have a large area under cotton production have a higher net profit than those having a small area. It is the same for the fixed charges that have a negative effect and significant at the 5% level on the profitability of the production of onion. Therefore, the more these expenses amounted less the producer benefits from his plantation. Table 7 shows the results of estimation of multiple linear regression model performed.

Table 7: Estimated multiple linear regression models.


*** = Significant at 1%; ** = significant at 5%; * = Significant at 10%

Source: Estimation Results, 2018.

Source: Estimation Results, 2018.

Onion importance for farmers: The onion producers constitute the largest actors group in the in the sector. Therefore, this production contributes to job creation for over 75% of agricultural assets during market gardening seasons in different regions of the study area. At the household level, onion cultivation is an important source of income and contributes to food and income security for producers. The onion is often the biggest source of cash income and helps to meet the needs of families. At Grand-Popo, as in all the investigated cities (Cotonou, Seme-Kpodji), deferred selling garden products, particularly onion is a powerful lever to support the food security of urban populations. As an activity of counter-season, onion belts allow producers not only to self-employed, to ensure household food security but also to receive significant revenue.

98% of surveyed producers recognized that onion production has resulted in many changes in their socio-economic life. In general, improving purchasing power has had a positive impact on food security, education and health situation of farmers. The onion income often also generates new income-generating activities such as petty trading, farming and others. Culturally, onion helps to prepare for marriage or pilgrimage to Mecca. Woman A and Man B two onion producers of Grand Popo and Cotonou asserted: ‘Onion production is very important to us. With this production I am more and more autonomous. I depend less on my husband. I don’t expect him anymore before buying coal or kitchen utensils. I do all my small expenses through this production income and I can even pay my tontine which was very difficult for me when I was not market gardner’ (A).’Onion is very profitable. I produce a lot of vegetables but little counter-season onion i produce, I can invest in my livestock and it is the same money that allow me paying my three children’s scholar fees each year’ (B).

Importance for input suppliers and other service providers

To carry out their activities, onion producers have much contact with a range of actors that are upstream in the value chain. Producers purchase pumps and pipes, gasoline, seeds, plows and small equipment, fertilizers and pesticides. Then, there is all kinds of economic relations between producers and suppliers, including the informal credit provision. The majority of the production costs regarding labor. Indeed, the onion sector creates many jobs, often for the poor. There is a redistribution of income from large producers to small producers, landless people in rural exodus through the agricultural labor. In most cases, producers raise funds to run production without financial institutions credit. Man C a Cotonou seed seller confirms these observations through these words:

‘In general market garden production allows us seed sellers to us to quickly sell our products in the city. Most of the time, people come to take the seeds of garden crops like onion and tomato. Many people feed through production. Carriers, agricultural equipment vendors, laborers ... ‘ (C)

Health and nutritional importance for producers-self consumer

Some market gardeners (6%) produce the onion just for its nutritional and health importance. For these producers, onion is a valuable culture that they not only produce for sale but also and especially for its therapeutic properties, organoleptic qualities and anti-erosive effect. Three onion self-consumers Men D, E and Woman F justify the importance of the Niger’s purple gold in their diet and their health situations.

‘The onion gives the taste and flavor. You can prepare a good sauce without putting a little onion. It is sometimes used to garnish the food or mitigate the effect of spicy chili’ (D)

‘The onion comes in many herbal tea in traditional therapies. When crushed with other products such as garlic, Goussi and others that can heal digestive problems, cancer, liver, rheumatism. It also helps to regulate menstruation cycle of women. My grandfather suffered from high blood pressure but with the adequate consumption of onions, it’s much better for a while ‘ (E)

‘The onion can be used in all forms: raw for salads, for example, cooked for frying or sauce, cut, beads, rapped or crushed. Onion juice can treat skin acne and provides a smooth and beautiful skin, as well as for hair growth and maintenance, colds, coughs, to sexual arousal’ (F). Figure 3 presents the advantages of onion production in southern Benin.

Figure 3: Importance of onion production in southern Benin.

Source: RResults of investigation, 2018.


Obstacles and expectations of onion producers in south benin

Onion production despite the many benefits that it brings to market gardeners, is facing various difficulties. Analysis of the Table 8 shows that the major constraints identified in onion production in southern Benin are institutional organizational, financial, land orders, and those directly related to production. The market gardeners interviewed affirmed that these constraints were also those for which it was essential that one find solutions. Among the most relevant constraints mentioned by farmers are: the lack of specific inputs for vegetable (onion), strong parasite pressure not control pests and vegetation in stock, the still extensive production system and low yields, low technical capacity of producers, difficult access to credit, poor organization of the onion sector in Benin, the lack of organization of market gardeners in general, deforestation and soil impoverishment, difficult harvest evacuation due to the degradation of most of the tracks, the low involvement of technical extension services, low supply of local services for the supply and distribution of specific inputs, lack of arable land, delay and poor distribution of rainfall in time and space and finally shortening the rainfall cycle.

Table 8: Constraints of onion production and relevance of these constraints by producers.


Source: Results of investigation, 2018.

These results are in the same direction as those obtained by Gotoechan-Hodonou [38] in northern Benin, attic of the onion production. Baco [31] also identified similar constraints in their studies in the field of seed production. The context of the difficulties faced by onion farmers in southern Benin is similar to the case of Niger where the constraints identified were the poor quality and availability of inputs and equipment, problems of access to certified seeds, low financial capacity producers, poor access and insufficient agricultural credit, poor mastery of production techniques, a lack of modern storage infrastructure and huge losses in stock, the traditional character of the transformation, the lack of appropriate packaging the variability of the weight of the bag, the existence of different methods of fixing and price volatility, weak infrastructure and road harassment [39], market saturation after the third cycle of production, the lack of regulatory mechanism supply and demand and competition from foreign imports in the sub-region39. However, among the identified constraints, are institutional, organizational and financial coming to the forefront. It is therefore imperative that the public and private agricultural institutions orient their policies in a process of facilitation and development of onion production in Benin. Despite the efforts, the producers of South Benin still face enormous difficulties that significantly hamper production. Producers have issued many approaches that could improve production conditions and therefore their living conditions. The most important approaches proposed by the producers were related to the main constraints mentioned. Man X and Woman Y, two onion producers argued about it, respectively:

‘We know that we are in cities, so with regard to the land is lacking but we did not complain too much. But there are things the government can do to make our job easier. For example, they can create agricultural credit services for onion producers, they can put us in group; can also be formed on the most effective technologies of production. It is necessary that the state helps.’ (X)

‘It is difficult to produce in cities, but we mostly need help. We receive no government support. Nobody supervises us, we cope alone. We would like the state begins to take us for help. The state focuses on cotton or cashew forgetting that gardening provides food security especially those urban populations. I don’t know if they know but especially gardening onion production is more profitable than cotton. I have produced cotton in the North before coming south for work. But finally I gave myself to the production of onion because it gives me more revenue especially against season. I strongly urge agricultural institutions to find us improved varieties of onion seeds, financing for irrigation and the launch of activities, organizing into cooperatives and especially we organize training courses.’ (Y)


Onion production is a very important sector which may be considered not only to ensure food security of urban populations but also to improve the living conditions of the producers. This production proves very financially profitable for producers in southern Benin. In addition to its financial performance, it also impacts on social, health, nutritional and environmental producers living. It allows a large number of producers and a considerable number of actors as service providers to have substantial income. However, it would be interesting for agricultural policies to develop actions to limit constraints of this production in southern Benin.

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Tuesday 27 October 2020

Lupine Publishers | One plus One is More Than Two? Reaping From the Synergy between Indigenous and Scientific Knowledge to Climate Adaptation in Ghana

  Lupine Publishers | Current Investigations in Agriculture and Current Research


The rapid escalation and dangers of global climate change is bourgeoning astronomically and thus places colossal demands on stakeholders to marshal innovative ways and processes for connecting knowledge systems to tackle its negative upshots. These demands in contemporary climate related discourses have led to calls for the integration of indigenous knowledge (IK) and scientific knowledge (SK) sources in climate adaptation efforts. However, studies that advocate and utilize the co-production of IK and SK as the way forward to climate adaptation efforts in Ghana remain scanty. This paper supports by reporting promising outcomes in economies that have embraced the co-production of IK and SK into their adaptation action plans. It is envisaged that this paper will spark stakeholder discussions and subsequently galvanize efforts leading to the integration of both IK and SK into adaptation policies in Ghana. Thus, one plus one can be more than two should Ghana thread on the path of knowledge co-production in climate adaptation initiatives.

Keywords: Global climate change; Indigenous knowledge; Scientific knowledge; Climate adaptation


Copious evidence supports climate change-induced decline in crop and livestock productivity in the global landscape [1,2] , more especially in weather-sensitive agricultural production regions such as sub-Saharan Africa where those most vulnerable to these impacts are the indigenous people whose source of livelihood depends solely on small-scale farming. Presently, the agricultural sector contributes 22% of Ghana’s GDP [3] and employs 42% of the economically active workforce [4]. In 2017, Ghana’s GDP recorded a growth rate of 8.5%, with the agriculture sector expanding from a growth rate of 3.0 percent in 2016 to 8.4 percent in 2017 [5]. Nonetheless, the agricultural sector is extremely imperiled as the EPA of Ghana predicts that the country stance to lose about 81.3 square meters of arable land yearly, and yields of maize and other cereal crops will reduce by 7 percent by 2050. This creates the urgency for best-fit climate adaptation practices to aid adaptation efforts by small-scale farmers, on whom the whole country depends mostly for food supplies. Thus, contemporary adaptation planning necessitates access to the preeminent available knowledge, whatever its source. Unfortunately in Ghana, there exists low levels of awareness and poor understanding of climate change impacts coupled with significant knowledge gaps about climate change processes [6]. These realities have mired effective societal decision making of climate change adaptation and mitigation. There is therefore the need to create such awareness and also integrate indigenous climate change adaptation and mitigation planning with sustainable development and poverty reduction goals [7].

In the light of this, countless developmental projects are known to have been created, funded and accomplished by outside resources and presented into rural communities with the hopes and promises of impacting the lives of small-scale farmers. Assessments indicate that these projects failed to recognize the culture of the people and resulted in low participation and success rates [8,9].As a consequence of these letdowns, there was a growing interest in the incorporation of indigenous knowledge (IK) and traditions to increase project participation rate and provide environmentally sound approaches to development. The main reasons for this paradigm shift towards indigenous knowledge and practices were (i) IK stem from the cultural context of the people concerned, (ii) IK evolves in close contact with the specific environment conditions and, (iii) IK is based on intimate knowledge of the environment in the traditional societies Mathias, 1995. Also, according to Adugna [10] and Woodley [11], IK adds value to climate change studies in the following ways; (i) IK systems create a moral economy, (ii) identifies a person within a cultural context, therefore providing decision-making processes or rules of thumb to be followed based on observed indicators or relationships within events, (iii) indigenous knowledge is progressively demonstrating a semblance with scientific methods as many ideas in indigenous knowledge that were once viewed as primitive and misguided, are now seen as appropriate and sophisticated, and (iv) indigenous knowledge systems provide mechanisms for participatory approaches. Valuable local knowledge of relevance to climate change assessment and adaptation is held by rural societies [12]. Thus, these sources see farmers in the agriculture sector as innovators with a sophisticated body of ‘indigenous knowledge’ comprised of practices gained through experience and transmitted through members of a community [13,14].

Extensive evidence of academic literature that documents how smallholder farmers use knowledge systems to adapt to climatic trends in Africa exist [15-17]. Owusu Ansah [18] in a study that examined indigenous knowledge sources, potency and practices to climate adaptation in the small scale farming sector cited 49 sources to indigenous knowledge in an article for the Journal of Earth Science and Climatic change. Crate [19], referenced 136 sources on climate change and culture in an article for the Annual Review of Anthropology. The United Nations Education, Scientific and Cultural Organization (UNESCO) and the United Nation University (UNU) [20] cited over 300 references in the 2012 report “Weathering Uncertainty: Traditional Knowledge for Climate Change Assessment and Adaptation”, which offers a synopsis of key issues and areas of research on indigenous knowledge. UNFCCC [21] ascertained the importance of indigenous knowledge conservation as key to the benefits of an ecosystems-based approach to climate adaptation.

The rapid acceleration and enormity of global environmental change places colossal demands on humanity to marshal innovative ways and processes for connecting knowledge systems that are conducive to sustainability learning and recognize the convolutions of socio–ecological systems and the challenges of the anthropocene [22,23]. In recent years, there has been a growing awareness that scientific knowledge (SK) alone is inadequate for solving the climate crisis [24] which has led to growing recognition of local, indigenous, traditional knowledge as an important source of climate knowledge and adaptation strategies. Byg [25] contend that it is erroneous to understand social ecological issues based on SK alone. Thus, the role of indigenous knowledge in climate adaptation in Ghana is required to buttress scientific knowledge adoption [26]. On the other hand, the challenges brought on by global climate change are beyond the lived experience of all knowledge holders, whether scientific or indigenous [27,28]. Owusu Ansah [18] opined that the utilization and efficacies of IK remained indubitable for decades but owing to recent unpredictability in the observed changes in the environment, coupled with the fast increasing susceptibilities of communities to climate change, absolute reliance on the sources of indigenous indicators for correctly predicting environmental changes have become more difficult and obsolete for farmers. Also, the potencies of the identified IK adaptation practices for yielding perfect responses to changes in the environment have become riskier and challenging as time goes by. Even though the relevance of indigenous knowledge sources and practices remain indispensable in the struggle to adapt to climate change, efforts will be more promising should there be a co-production of other knowledge sets (science based) to buttress established positive practices in IK Owusu Ansah [18]. This has led to several calls for interdisciplinary climate change research in modern studies [29-31]. Gratani et al. [32], show that integration of traditional knowledge through scientific validation can be respectful and empowering. To succeed, we cannot afford to lose insights and information originating from multiple knowledge systems [33].

However, studies that advocate and utilize the co-production of multiple knowledge systems that integrate IK and SK as the way forward to climate adaptation efforts in Ghana remain scanty. Aside from the relatively significant physiognomies of spatial locations in climate change manifestations on the global scale, existing literature on the subject is unsatisfactorily scanty in the context of sub-Saharan Africa and Ghana in part [18]. Thus, this paper reviews studies that have presented promising findings from the incorporation of IK and SK elsewhere to inform new approaches to climate adaptation in Ghana. In the face of climate change risks and impacts that remain uncertain and unpredictable, there is a growing need for policies and action that foster the co-production of new knowledge sets, based upon collaborative efforts involving IK and SK holders. Co-management regimes that bring communities and the State together to jointly manage natural resources, have provided an important arena for the development of knowledge coproduction [34-36].

Reaping From the Synergy: One Plus One is More Than Two

Studies by scholars provide examples from across the globe where the recognition of complementarities across knowledge systems have advanced the understanding, and in many cases improved management, of ecosystems, critical natural resources, and biodiversity. In Africa according to Guthiga and Newsham, (2011) and Kalanda Joshua et al. [37], rainmakers in the Nganyi community of western Kenya and farmers in Nessa Village in southern Malawi have worked in partnership with meteorological scientists to create integrated forecasts that are being disseminated by both indigenous and conventional methods to enhance community resilience to climate change and its adversarial upshots. Uganda [38] highlighted the maintenance, protection and continuity of the use of indigenous knowledge in the management of natural resources as a project in its National Adaptation Programmes of Action (NAPA). Also, Ethiopia included the documentation and advancement of indigenous rangeland resource management as a way to enhance resource management practices. Mozambique incorporated the role of local forecasting knowledge in strengthened early warning systems for detecting changes in the environment. The United Republic of Tanzania [39] encouraged the promotion of indigenous knowledge in the agriculture sector.

In Cape Verde, the Ministry of Environment and Agriculture promoted the need to understand traditional knowledge in relation to variations in the water cycle and agro-silvo-pastoral production systems. In 2008, Liberia recognized the necessity to better integrate indigenous and effective coping strategies into its national development policy and planning in order to better respond to the growing incidence and intensity of climatic shocks so that the country will be in a better position to address the situation within the context of its existing sustainable development policy processes. In West Africa, an initiative has been piloted by the Association for Indigenous Women and Peoples of Chad, the Indigenous Peoples of Africa Coordinating Committee and UNESCO, which brought together pastoralist M’bororo weather forecasting knowledge with scientific seasonal and long-term forecasts. This initiative is grounded on a sequence of discussions and exchanges between indigenous and scientific knowledge holders, with the support of indigenous knowledge experts [40]. This initiative occasioned instances where Meteorological services integrated indigenous knowledge, such as phenological data, into their projections to provide users with more broadly based information [41]. In Kenya and Ghana, multiple avenues of culturally appropriate communications are used to ensure that advisories and forecasts are disseminated to farmers and livestock keepers [42]. Also, CARE International’s “Joto Afrika: Climate communication for adaptation” provides an example of a platform where SK provides data for IK holders to assess their decision-making on when to plant. By providing the capacity to develop rainfall records from their own community rain gauges, agro pastoralists can take informed decisions on planting dates.

Based on a report by ACIA [43], The Arctic Council’s Arctic Climate Impact Assessment is a successful approach to the collaboration of IK with SK that resulted in the incorporation of a broad set of observations from indigenous peoples alongside a regional assessment of the impacts of climate change in the Arctic. This brought together representatives of IK and SK holders on the Artic Council to cooperate and integrate both knowledge sources into a report that produced two chapters on indigenous perspectives and incorporated nine case studies into the final report. Such collaboration led to a robust knowledge base on the impacts of climate change on the Arctic, with indigenous and scientific knowledge supporting each other [43,44].


Transforming governance of biodiversity and ecosystems toward sustainability will require a rich understanding of the complex interactions of people and nature at different scales, and of the drivers and feedbacks that affects these interactions [45]. The rapid acceleration and enormity of global environmental change places colossal demands on humanity to marshal innovative ways and processes for connecting knowledge systems that are conducive to sustainability learning and recognize the convolutions of socio– ecological systems. We argue that to achieve this, the science-policy community needs to embrace a diversity of knowledge systems, and when connecting to knowledge from local or indigenous communities, it must think beyond aspects that can easily be fitted into conventional models and frameworks. Also, the partial success of the use of traditional knowledge in coping with climate change leads to the conclusion that a healthy relationship between scientific knowledge and traditional or indigenous knowledge – which both have their limitations – is desirable, especially in developing countries where technology for prediction and modeling is least developed [46]. We therefore suggest that, in the face of climate change risks and impacts that remain uncertain and unpredictable, there is an increasing need for procedures and measures that nurture the coproduction of new knowledge sets, grounded on collaborative energies encompassing community-based knowledge holders and natural and social scientists to tackle the climate change bottlenecks that engulf Ghana [18]. Our study demonstrates that understanding and use of climate adaptation strategies should be overarching in the context of Ghana to incorporate indigenous and scientific knowledge to achieve a counterbalance. Through this, the strengths of both knowledge sources will combine to produce promising returns that could be achieved individually; one plus one is more than two [47,48]. Therefore, an understanding established on multiple evidences can afford stronger confidence in conclusions where knowledge and understanding converge across knowledge systems. Our findings accentuate the quintessential requirement for efforts that embrace continuous training and education on climate-smart farming practices, on-hand provision of extension officers and up-to-date meteorological data, constant supply of farm inputs and inculcate partnerships and periodic organization of regional-district-community workshops or forums that bring together IK and SK holders to forge new set of measures and mitigating strategies to adeptly tackle climate-induced challenges on the agriculture sector of Ghana.

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Friday 23 October 2020

Lupine Publishers | Lasers & Pedodontics

 Lupine Publishers | Journal of Pediatric Dentistry


The medical terms such as magical and lightening quick are used to represent lasers [1]. Theodore H. Maiman in 1960 coined the term laser, which was initially termed as maser which stands for “microwave amplification by stimulated emission of radiation”. However, the term LASER is an acronym for light amplification by stimulated emission of radiation [2,3]. Three types of lasers used for surgical therapy in the oral cavity are neodymium lasers - YAG (Nd: YAG), of argon (Ar) and carbon dioxide (CO2) [3]. Lasers have largely replaced scalpels and other instruments in the field of medicine because of its advantages [4-6]. Different laser wavelengths have different absorption coefficients wherein laser energy can be absorbed or transmitted based on the structure of the target tissue. The presence of water, which is an essential component of all biologic tissues, is important for the use of lasers [2,6]. For hard tissues, Er lasers are used whereas any laser can be used for soft tissue components [2,6,7].

Applications of Lasers in Pediatric Dentistry

For caries removal

Erbium group of lasers are preferred for deep enamel, dentin, and caries removal, whereas the Nd: YAG laser is designated for superficial pigmented caries removal. The other advantages being the non-requirement of anesthesia and the use of conventional drills, which cause micro-fracture of tooth during preparation [1,2]. During cavity preparation, after the removal of enamel, the settings are adjusted to reduce the energy levels as dentin is less mineralized and has higher water content than enamel [2].

Removal of restorations (including amalgam)

Lasers should never be directed towards amalgam and should be pointed towards the surrounding enamel to create a small trough, and hand instruments are used to elevate the restoration out and later the cavity preparation is completed. Also, other restorations like composite and glass ionomer can be removed/replaced [1,2].

Preventive treatment

At the early stages after tooth eruption, enamel grooves are the site of early caries. This can be treated using lasers by cleaning, sterilizing and restoring the same. Also, many studies have reported that etched enamel by erbium has properties like the acid-etched enamel [2].

Treatment of peri coronal problems in erupting teeth

Lasers are used in non-contact mode to remove the pericoronal tissue covering the newly erupted tooth, which might help in relieving any discomfort, swelling, or infection in the tissue overlying the emerging tooth [2,9].

Gingival re-contouring and orthodontic purposes

Excess gingival growth by the use drugs or by poor oral hygiene, and during other surgical procedures including orthodontics requires removal of tissue in some cases. This can be accomplished by the use of lasers which can be done without the need for a local anesthesia. Use of topical anesthetic can be supplemented for the treatment procedures [8].

Treatment of ankyloglossia

Tongue is stabilized with a hemostat and the frenum is revised, while avoiding any damage to the glands on the floor of the mouth [8].

Treatment of aphthous ulcers and herpetic lesions

Use of low power settings with the laser energy directed at the target tissue in the non-contact mode, for a duration of 15-30 second intervals for three to four times, helps in pain relief. The use of laser in the initial stages in herpes labialis may prevent its further progression and provide a palliative effect for the area and prevent its progression [2,8].

Pulp therapy

The ability of laser to close the dentinal tubules and provide a sedative effect on pulpitis has somewhat encouraged the use of laser in indirect pulp capping [8]. Also, the use of lasers to sterilize the canals and also create a hemostatic environment in adjunct to the conventional procedures has created a stir for the use of lasers.

Other surgical procedures

Other surgical procedures like apicectomies and amputation of impacted teeth underneath the bone also can be performed with the use of lasers. The erbium lasers are ideal for these surgeries and a variety of tips, settings and water sprays can be used. Softtissue ablation does not require water spray whereas removal of bone needs to be done with water [2,9].

Advantages of laser therapy

a) Decreasing inflammation and pain.

b) Reduced healing period [3,4,9].

c) Good & faster healing properties.

d) Reduced chances of infection.

e) Reduced bleeding.

f) Instant hemostatic achievement.

g) Good margins.

h) Patients apprehensive for blade.

Contraindication of Laser Therapy

a) Patients with pacemakers, however it can be used with precautions in some case [9].

b) Patients who are sensible to light.

c) In epileptic patients.

d) In patients with antecedent of arrhythmia or chest pain.

e) Avoided on tumorous tissues or benign tumors with malignant potential.


Natural light is and has been considered as the curator [10]. Lasers have gained tremendously over the years; its advantages far outweigh its disadvantages. However, there still exists some limitations as well as some contraindications, which stop its usage with the cost factor being one of it. Nevertheless, it would be the future instrument of choice for most of the procedures included in all the fields with surgery, periodontics, endodontics and orthodontics being one of them.

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Thursday 22 October 2020

Lupine Publishers | Injuries to Ear Ossicles

 Lupine Publishers | Journal of Otolaryngology


There are different types of injures to ear ossicles including ossicular chain dislocation, which is separation of the middle ear bones. It results in a hearing loss due to sound not being transmitted properly (conductive hearing loss). Its causes are fracture of one of the bones at the side or base of the skull (temporal bone), a hole in the eardrum that is caused by trauma (tympanic membrane perforation), chronic otitis media or Cholesteatoma.


The fractures of temporal bone may be: Longitudinal usually occur with a temporoparietal blow & cause conductive deafness due to ossicular disruption. SNHL is rare & can occur due to cochlear concussion. Usually do not cross otic. Transverse typically results from an occipital blow and runs along the length of petrous bone towards petrous apex. It has medial & lateral subtypes. Medial traverses the fundus of the IAC & SNHL may be sec. to cochlear nerve transection. Lateral traverses the bony labyrinth & is often associated with a perilymphatic fistula. Oblique fractures, also called mixed or complex fractures, are the most common types, followed by longitudinal and transverse fractures [1-3]. Ossicular chain dislocation may occur with a temporal bone fracture, traumatic tympanic membrane perforation, head injury or barotrauma. Longitudinal fracture usually occurs with a temporoparietal blow & causes conductive deafness due to ossicular disruption. SNHL is rare & can occur due to cochlear concussion. The most common form of ossicular dislocation after temporal bone trauma is separation of the joint connecting the incus to the stapes. The second most common is separation of the joint connecting the malleus to the incus. Fracture of the arch stapes may also occur. The tympanic membrane may or may not be perforated. The causes are external injury to temporal bone, injury by knitting needle, ear bud or pick. The incus is relatively vulnerable to traumatic dislocations (incudostapedial) on account of its weakly anchored position between the firmly attached malleus and stapes. After severe skull trauma also, the incus may suffer dislocation. Malleoincudal dislocation may also occur [4-6]. The incus is relatively vulnerable to traumatic dislocations (incudostapedial) on account of its weakly anchored position between the firmly attached malleus and stapes. After severe skull trauma also, the incus may suffer dislocation. Malleoincudal dislocation may also occur. Complications: perilymphatic fistula, CSF fistula [7], ossicular disruption-commonly incus and Cholesteatoma, 7th nerve paralysis due to fracture extending into facial nerve canal. It may also extend into lachrymal gland. Penetrating traumas through the external ear canal may also cause dislocation of the incus. The incus may remain in the epitympanic recess, dislocate to the most inferior portion of the tympanic cavity or of the external ear canal, or even be destroyed. A thorough evaluation by means of computed tomography in axial and coronal planes of the middle ear and external acoustic meatus is necessary to identify the exact position of the incus in relation to the malleus and the stapes. A unique case of an ossicular chain injury was reported in a young man. Even though the patient’s incus was dislocated into the external auditory canal while remaining attached to the stapes, his hearing was not affected and remained nearly normal. Rarely incus has been reported to extend into vestibule, carotid canal or tympanic membrane [2,3]. The causes are external injury to temporal bone, injury by knitting needle, ear bud or pick. Thomsen (3) reported a material of 40 patients with diagnosis of dislocation of the incus is presented. 37 of these patients had either a history of cranial trauma, or information about previous simple mastoidectomy or paracentesis the ossicles are deprived of their essential blood supply and yet nearly unharmed. Nilesh Gupta, Dr. Manish Meshram [4] reported a rare case of dislocation of incus into the external acoustic canal following a fall from stairs with head injury.

CT scan revealed disrupting the Ossicular chain with disarticulation of malleolo-incudal joint and dislocation of incus. bony fragment, giving appearance as shape of incus, noted in the postero-inferior region of right external ear canal. Micro-Otoscopy, 10 days after injury, revealed an intact tympanic membrane covering the fractured - dislocated incus. The fractured segment was displaced and attached to the postero-inferior aspect of the external auditory canal. The other injuries are: malleoincudal joint dislocation, Stapediovestibular dislocation, Stapediovestibular dislocation, Labyrinthine fractures, Dural fistulas, facial paralysis or injury to carotid canal. Tympanic membrane may or may not be perforated. The causes are external injury to temporal bone, injury by knitting needle, ear bud or pick. Treatment in any case is middle ear exploration and ossicular chain reconstruction. This surgery is essentially the same as tympanoplasty; however, there is no hole in the tympanic membrane to fix. Sometimes, the surgery can be performed though the ear canal rather than having to make an incision behind the ear.


Our hospital is a tertiary care center for head injury. Our experience over a period of 12 years is presented with illustrations.


a) Case 1: Normal linear and curvilinear structures must not be mistake fractures (pseudo fractures): cochlear & vestibular aqueducts, sutures, mastoid canaliculus, ITC, singular & subarcuate canals. These are illustrated in the Figures 1a-1d.

Figure 1:
a. Subarcuate canal (arrow) carrying nerve and vessel.
b. Superior temporal suture (arrow).
c. Cochlear aqueduct.
d. Vestibular aqueduct (arrow) and glossopharyngeal nerve canal (straight line).



Images showing pseudo fractures are presented, not to be mistaken for fractures (Figures 2-11). A few typical fractures and complications seen on CT Cisternography are also illustrated, from our experience in nearly 8 years. Dislocation of incus is rare indeed but has been reported with a large in number in some series.

Figure 2: This image reveals a longitudinal fracture of petrous bone on left with hemorrhage in tympanic cavity and includemalleolar dislocation.


Figure 3: Shows a transverse fracture of petrous bone crossing the turns of vestibule.


Figure 4: Another case of transverse fracture. A Transverse fracture of petrous bone is seen reaching horizontal semi-circular canal and causing hemotympanum.


Figure 5: Hemorrhage in external auditory canal and middle ear due to a longitudinal fracture.


Figure 6: Images of CT show disturbed ice-cream appearance of incus and malleolus.


Figure 7: HRCT of mastoid images (upper row axial views and lower row coronal views show incus dislocation (extruded into external auditory meatus. [7] Oculoplastic was carried out.


Figure 8: H/o head injury due to Otorrhea due to small leak beneath defect in tegmen tympani on right side.


Figure 9: 45-year-old male, H/O mastoidectomy in the past. C/O watery discharge from ear. CT reveals a defect in mastoid filled with CSF density lesion. MR confirms.


Figure 10: This 11-year-old boy C/O - Repeated attacks of meningitis, operated for CSF fistula. He continues to have attacks of meningitis. Nuclear scan – increased activity in the neck on left. CT cistern gram confirms leakage into genicular fossa and then near the mastoid tip.


Figure 11: CT cistern gram shows opacification of mastoid cells and antrum as a complication of surgery for acoustic neuroma.